The launch of Rayner’s world-first spiral IOLs in Barcelona last year set tongues wagging in the global ophthalmic community. Early adopters in Australasia discuss how the all-new design measures up.
Mr Lourens van Zyl’s mother can rest easy. So can many of his patients who have waited for this moment – even delayed their own cataract surgery in anticipation of an intraocular lens (IOL) that ticks more boxes than any other he has previously used.
The world’s first spiral IOL has arrived. The RayOne Galaxy and RayOne Galaxy Toric lenses are now available in Australia, and it appears surgeons and their patients can’t wait to get their hands on what has been described as the “next evolutionary step” in IOL technology.
Dr van Zyl goes a little further.
The eye surgeon at Perth’s Crystal Eye & Laser Centre, who was one of the first practitioners in Australia to use the new lenses, says the latest offering from UK-based manufacturer Rayner is “absolutely the closest we’ll get to the holy grail of lenses”.
“What we’re looking for is good near, good distance, good intermediate vision, with almost no night-time symptoms,” he says.
“This is it.”
So impressed is he that he would happily offer the IOL to his mother.
Other surgeons Insight spoke to, including Dr David Gunn and Dr Ben LaHood, are also excited about the promise Rayner’s newest offering holds, which they described as a “refractive full range of vision lens.”.
RayOne Galaxy caused a big stir at the European Society of Cataract and Refractive Surgeons Congress in Barcelona last year, where over 600 surgeons packed a lunchtime symposium moderated by Dr Başak Bostancı (Turkey) to hear from a number of early implanters, including Mr Allon Barsam (UK), Professor Claudette Abela-Formanek (Austria), Dr Alain Saad (France) and Dr Dean Corbett (New Zealand).
They reported that the lens, designed using a proprietary AI engine trained on patient outcomes and the expertise of Brazilian ophthalmologist Dr João Lyra, was indeed worthy of that excitement.
The company says that RayOne Galaxy’s unique spiral delivers a continuous full range of vision with minimised dysphotopsia, achieved through a non-diffractive optic with 0% diffractive light loss.
The surgeons reported excellent early outcomes and discussed how the spiral optic works to elongate focus and minimise dysphotopsia.
Dr Corbett presented video testimonials from his first two patients, who reported excellent visual acuity with no halos or bothersome night-time visual disturbance.
He has now implanted the IOLs in at least 30 patients, and he says they are happy with the IOL’s performance, their “great near vision and the lack of halos”.
One of his patients, an 80-year-old male said that “I can read that very small print which I certainly couldn’t do before’ and ‘I can see the birds in the trees”.
He also compared his night vision while driving with that of his wife, who has bilateral diffractive bifocals, and was ecstatic that he does not experience the halo and glare that she does.
For Dr van Zyl, about 90% of his work is refractive cataract surgery and he uses a number of Rayner products because he likes the range and the ease of use during surgery.
“I use the RayOne EMV lens quite extensively, and I also use the aspheric lens a lot in patients who want Presbyond [laser surgery] or who have cataracts.”
But he has steered away from multifocal lenses in the past because of the diffractive pattern, the glare and night halos they usually bring.
“My preference is an extended depth-of-focus lens.”
Often, he has needed to explain to patients that such lenses can come with compromises.
“I tell patients that there’s no free lunch,” he says. “I’m not God or Jesus. You will have to compromise somewhere.”
That has often meant putting up with compromised near-vision, and halos at night, making driving late difficult, even dangerous in some cases.
But he has been very impressed, and a little surprised, at the ability of the RayOne Galaxy lenses to deliver excellent vision across the board, and particularly the big challenge of near vision, all while minimising halos and glare.
At time of writing, Dr van Zyl had implanted the Galaxy IOLs into 12 patients.
“The fact that they have excellent near vision with distance vision and a good range, obviously, I think Rayner has [launched] something as close to the holy grail as we can probably get at the moment.”
Social media chatter meant that many of his patients had also picked up on that buzz and had delayed their surgery so they could get access to the RayOne Galaxy IOLs.
They won’t need to wait long now, after Rayner released them into the Australian market in January 2025. However, the company is yet to gain Prostheses List (PL) approval allowing healthcare reimbursement.
That is unlikely to be a deterrent for many people, says Dr van Zyl, and particularly those patients wanting to be free of their spectacles.
It’s a great lens for the surgeon to use as well.
That meant the product would be ideal for those looking to venture into offering more advanced lens designs to patients.
“I think the RayOne Galaxy lens is the gateway product for a general ophthalmologist to go into vision correction surgery. It’s a very easy lens for young surgeons who are a bit wary of premium lenses.”
Excellent early results
At this early stage, Dr Gunn, from the Queensland Eye Institute, is a little more cautious than his WA counterpart, but says the lens shows a lot of promise.
About 80% of his IOL implants are presbyopia-correcting IOLs and toric, and he uses products from all of the major manufacturers.
At time of writing, he had implanted the RayOne Galaxy IOL in 10 patients.
They had reported excellent results.
“My first case, the patient had a complete range of focus, zero halo, zero glare,” he says.
“She’s like, ‘I’ve never seen like this in my life, my vision is perfect; I’ve got no issues at night’.”
But one swallow doesn’t make a summer, and Dr Gunn is looking forward to seeing the longer follow-up of the multicentre data evaluation.
Like Dr van Zyl, he has patients who have done their research, picked up on the excitement and are now queueing up to use the RayOne Galaxy IOLs, even if that means paying out of their own pocket for now.
They are eager. So is Dr Gunn, in part because he’s been following the development of the technology for some time.
“I’d heard a bit about spiral optics before, and I just love that idea, to be able to give a patient a full range of vision, giving them distance into being near, but not needing diffractive rings and all the issues that come with that design.”
He believes there will be many patients, particularly younger ones keen to be spectacle-independent, who will be ideal candidates for the RayOne Galaxy IOLs. And he believes that group will grow larger when the RayOne Galaxy IOLs are approved on the PL.
“Maybe those patients who couldn’t have had a diffractive multifocal suddenly can have a spiral optics lens.”
‘Good continuous range of vision’
It was Dr LaHood, a consultant ophthalmologist at Adelaide Eye and Laser Centre, The Queen Elizabeth Hospital in Adelaide, and senior lecturer at the University of Adelaide, who said the RayOne Galaxy IOL was the “next evolutionary step” in the technology.
He stands by that claim, although, like Dr Gunn, he is eager to see the long-term outcomes.
Dr LaHood implanted his first Galaxy IOL in October last year, and now has 10 bilateral patients he continues to follow closely. He’s treating it as “another multifocal option alongside a traditional trifocal diffractive IOL”.
“So far, near-vision has been the first thing patients have noticed to be improved,” he says.
“Distance visual acuity has taken a little longer to reach a steady state.”
Now he is routinely getting 6/6 distance vision in those patients.
“Unlike standard trifocal implants, my patients are not as aware of ‘sweet spots’ of focus but rather a good continuous range of vision from distance to reading. This is consistent with defocus curve data from the early user group.”
His patients have not complained about halos.
Asked about advice for his colleagues, Dr LaHood says he hasn’t had any adverse events or refractive surprises but he would still consent patients they may have a higher risk of needing refractive laser enhancement, IOL exchange or even glasses – “simply because we do not yet have as much experience with this lens”.
“Personally, my experience has been that I have had to do fewer enhancement procedures compared to my standard trifocal cohort of patients, and this is reflected in the excellent prediction error data from the early user group.
“I recommend using the Barrett Universal II formula or Rayner’s Raytrace premium IOL calculator website which has been updated to include the PEARL-DGS formula from Damien Gatinel and colleagues. Aim for mild hyperopia with the current A-constant. Somewhere between plano and +0.25D should be sufficient.”
He’s consenting patients by asking them if they would prefer a trifocal with a longer history of usage, or the new Galaxy technology knowing that there’s still more to learn about the lens that doesn’t have reimbursement yet.
Overall, he felt that would help increase his candidates for full range of vision lenses and, long term, “I see it replacing the diffractive trifocal and eating into the EDOF mini-monovision space”.
“One of the key features that impresses me [about Rayner], has been that from CEO to local staff, the Rayner team have a great attitude towards surgeons, with great communication and making things happen,” Dr LaHood says.
“Despite their relatively smaller size, I am sure that these types of innovations, combined with their friendly team, will see Rayner become one of the big players in the eye world for years to come.”
More reading
Rayner introduces new and improved RayTrace
Rayner RayOne Galaxy ‘world’s first spiral IOL’
Rayner’s history of charting new territory
